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Three Years and 6,897,025 Deaths and Counting

In the year 2020, “A DEADLY GLOBAL PANDEMIC ON THE RISE?” crowded

newspaper headlines, and every other story were deemed with less importance. The word

“COVID-19” attracted the media like bees to honey. Our television, phone, and laptop screens

were bombarded by alarming updates about a deadly, unknown virus. Many people were left

with medically sophisticated information, scarce resources, and overwhelming anxiety about the

future. Hospitals were left with burnt-out healthcare workers, full-capacity units, and terribly ill

patients whose illnesses worsened with time. Students and teachers were kicked out of their

classrooms, and technology dominated schooling for three years.

I was sitting in my physical science class in South Dakota when our teacher notified us

about the school suspension attributed to COVID-19. As freshmen students, our faltering

attention spans and aloof demeanors quickly changed to confusion, excitement, and worry. Many

were occupied planning their days not doing homework and not attending the classes they slept

through. We did not know what was COVID-19. In one day, the halls that used to be filled with

lost, sweaty freshmen, struggling sophomores, nail-biting, test-taking juniors, and anxious,

graduating seniors were instead filled with an overwhelming sense of uncertainty. In a short

period of time, headlines read “COVID-19 SPREADS THROUGHOUT THE U.S.” Learning to

healthily cope with the new state of our lives was difficult to compartmentalize, especially

because many of us were plagued with the fear of contracting COVID-19.

The COVID-19 pandemic is one of the most-influential, sudden events in our lives,

especially in the lives of healthcare workers, adolescent children, and underserved communities.

Three years and 6,897,025 deaths later, thanks to innovation, research, and medicine, we now

have a semblance of normalcy—the emerging era of the “New Normal.” Today, we routinely

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take COVID-19 swab tests like brushing our teeth and wear masks as if they were part of our

wardrobe. We read about transmission rates, healthcare stories, and vaccination side effects like

trivial gossip in magazines during our free time. My frontline family members often discuss the

challenges they faced during the pinnacle of the pandemic. My mother, who is a nurse, often

talks about understaffing and overcrowding and often reaching full capacity in many floors. Due

to these experiences and conversations about how COVID-19 impacted everyone, I was

persuaded and intrigued to pursue a topic that focused on post-pandemic public health, which is

the reason why I wanted to investigate: How did the pandemic change in public health and

disease awareness, especially in underserved communities?

COVID-19 is a respiratory disease that is caused by severe acute respiratory syndrome:

SARS-CoV-2 (Briss). The COVID-19 pandemic is one of the most prominent public health

crises over the last few decades, causing a global health emergency. Public health is defined as

“the science and art of preventing disease, prolonging life, and promoting health through the

organized efforts and informed choices of society, organizations, public and private communities,

and individuals” (“Introduction to Public Health”). Prior to the pandemic, there was an

overwhelming deficiency in public health investments, which was an amalgamation of

systematic factors such as poor housing, lacking health education, and health inequity. The

pandemic forced communities to address these failing systems and create changes. Disease

prevention and awareness are increasingly prioritized and emphasized as the pandemic exposes

its adverse effects on health in communities: “The COVID-19 pandemic has had direct and

indirect effects on people with chronic disease…this pandemic has also raised concerns about

safely accessing health care and has reduced the ability to prevent or control chronic disease”

(Briss). Prior to the pandemic, chronic illness was one of the leading causes of death in the

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United States and COVID-19 exacerbated the vulnerability of people living with chronic

illnesses. These people were more susceptible to contracting COVID-19 and experiencing severe

health illnesses due to COVID-19. Interestingly, the COVID-19 pandemic has introduced a new

demographic of people with severe health conditions manifested by COVID-19. According to

Iwasaki, Long COVID-19 is categorized into two types: Post Severe COVID-19 Syndrome and

Post COVID-19 Fatigue Syndrome. 70 percent of Post Severe COVID-19 Syndrome patients

experience long-term symptoms such as fibrosis, tissue damage, and organ damage, while 10 to

30 percent of Post COVID-19 Fatigue Syndrome patients experience fatigue, brain fog,

postexertional malaise, and dysautonomia (Whitacre). These long lasting symptoms affecting

many organs can affect breathing and heartbeat. Iwasaki hypothesizes that manifestations are

prompted by different immune system adaptations or tissue damage. There are improvements in

long COVID-19 symptoms after vaccination. COVID-19 effects such as this have emphasized

the need to improve disease awareness and prevention in the United States: “Disease surveillance

is the backbone of any epidemic response, as it provides information about the sections of the

population most at risk, which helps develop targeted interventions to contain the disease spread

in the population” (Bashier). Disease awareness is effective when active disease prevention is

established and enforced. One lesson people have learned from the pandemic is the importance

of disease surveillance as it relates to effective containment and prevention of diseases,

especially in diverse populations with vulnerable communities.

The pandemic revealed the increased vulnerability of elders and people with

comorbidities and medical conditions. People ages 50-64 years have 25 times the higher risk of

death compared to people ages 18-29 years. Moreover, the risk of death, compared to those ages

18-29 years, is 60 times higher in ages 65 to 74 years, 140 times higher in ages 75 to 84 years,

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and 340 times higher in ages 85 years and up (“Underlying Medical Conditions”). Elderly

community members were one of the most vulnerable demographics, especially during the peak

of the pandemic. Considering a good majority of elders experience underlying medical

conditions such as diabetes, heart disease, and respiratory diseases, they were at higher risk of

contracting the virus and other diseases that potentially worsened their health conditions.

Regardless of age, people with comorbidities, or underlying medical conditions, experienced

worse health conditions and were put at a higher risk of contracting diseases. People at any age

who have lung, liver, kidney, and heart disease, cancer, diabetes, neurological problems,

weakened immune systems, and mental health issues were more susceptible to diseases during

the pandemic. There is a correlation between worsening health conditions and prior

comorbidities, according to Claudine Vallecera, a registered nurse who worked in the Midwest

during the first surges of COVID-19 cases and has extensive experience in different units due to

her travel nursing experiences. Pre-existing comorbidities have exacerbated the reactions of

people’s immune system to the virus. Heart disease, diabetes, cancer, chronic obstructive

pulmonary disease, chronic kidney disease, and obesity are all conditions that increase the risk

for severe illness from COVID-19. Other factors, including smoking and pregnancy, also

increase the risk. Not only does COVID-19 exacerbate these conditions, but they are also directly

correlated to the increasing death rate among people with chronic illnesses. Finally, in addition to

COVID-19–related deaths since February 1, 2020, an increase in deaths has been observed

among people with dementia, circulatory diseases, and diabetes among other causes (Briss). The

pandemic has emphasized the health issues among vulnerable communities attributed to

COVID-19. It is evident that vulnerable communities remain incapacitated by their ailments due

to various socioeconomic disparities in healthcare.

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Moreover, the pandemic reveals the inaccessibility of healthcare, which contributes to the

apparent disparities in ethnic communities such as financial burden, lacking health education,

and discrimination. The amalgamation of COVID-19 and chronic diseases such as heart disease,

diabetes, and cancer has exacerbated the risk of certain racial groups: “Some populations,

including those with low socioeconomic status and those of certain racial and ethnic groups,

including African American, Hispanic, and Native American, have a disproportionate burden of

chronic disease, SARS-CoV-2 infection, and COVID-19 diagnosis, hospitalization, and

mortality” (Briss). Chronic disease and other underlying illnesses have ravaged communities of

color evidently during the past few years; this is not a new occurrence or discovery, but the

pandemic has emphasized the pattern that people of color tend to suffer from diseases such as

diabetes and COVID-19 more frequently compared to other populations because there is an

inaccessibility of the healthcare system, especially if they live in rural areas. Communities of

color during the pandemic were at a severely higher risk of diseases because there was a lack of

resources and financial capacity: “Black and Hispanic communities also face greater financial

impacts, higher rates of infection, and higher rates of death. And, when age is taken into account,

the death rate for Black and Hispanic Americans is 3.6% and 2.5%, respectively, times that of

Whites, according to recent research from the Brookings Institution” (Graham). Due to the

disproportionate distribution of healthcare resources and options for people of color, there was an

alarming difference in infection and mortality rates; there are many minority communities where

the lack of health insurance is a great hindrance to accessing adequate healthcare. The scarcity of

health insurance in many communities of color is emblematic of the socioeconomic barriers they

must face: “People of color were also differently affected economically, Blumenthal commented,

as 32 percent of Black older adults (over age 65) and 39 percent of Hispanic older adults in the

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United States reported using their savings or losing their source of income because of the

pandemic, compared to just 14 percent of White older adults” (Whitacre). Socioeconomic and

racial inequities are not mutually exclusive; often, socioeconomic inequities are one of the many

disparities between communities of color and white communities. During the pandemic,

socioeconomic difficulties were one of the many factors that led to the disproportionately low

assistance to these vulnerable communities in states like Illinois, Louisiana, and Michigan:

“Chicago’s Racial Equity Rapid Response team implemented an informational campaign that

increased COVID-19 testing rates by 13%, performed preventative outreach calls to 68,000

patients, and secured $3.1 million in COVID-19 relief funding, which was used to address

community needs such as rental assistance” (Basset). To control this issue, many states have

issued programs that aid these communities in accessing better healthcare and the necessary

education and resources. These programs do not only help with disease prevention and

awareness, but also close the gaps in a previously faltering healthcare system. The pandemic has

allowed medical facilities, and legislatures to dwell on the problems and improve upon them to

create change, especially in vulnerable communities who have been overlooked.

Socioeconomically disadvantaged communities were put at greater risk during the

pandemic and continue to experience the consequences of poor circulation of resources in their

respective healthcare systems. In many states, poverty is a prominent issue that hinders progress

in health literacy and lifestyle: “For example, in Mississippi, approximately 20% of the

population lives in poverty. In 2019, Mississippi, Louisiana, Arkansas, and Alabama were ranked

as the country’s least healthy states'' (Burse). The healthcare systems in many counties do not

necessarily cater to socioeconomically disadvantaged communities; people living in rural areas

already have limited access to health education, resources, and medical facilities. Lack of

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financial assistance is a great feat many people are not able to overcome. Slowly, there are

improvements in the accessibility of healthcare; Buhat, whose passion for her profession as a

registered nurse can be felt through every word she uttered, said that many of her

socioeconomically disadvantaged patients have been aided by state and federal programs, social

workers, and medical facilities. Buhat emphasized how working in rural and even metropolitan

areas like Los Angeles, California and Rapid City, South Dakota, many patients lack the proper,

and even general, health education. Additionally, when working with patients from Native

American communities, some are part of the ‘frequent flyers’ list, which can be attributed to a

lack of resources and education that inevitably lead them to returning to medical facilities

frequently, according to Buhat. There is a general lack of education and resources for

socioeconomically disadvantaged and ethnic minority communities. The pandemic has been able

to uncover some of those problems and really emphasize how many issues there are in the

healthcare system with regards to patient care.

To mitigate public health emergencies and prepare for future health crises such as the

pandemic, education plays an important role in improving the healthcare system and public

health. The first step to eradicating health misinformation is the prioritization of healthcare

education: “To “inform, educate, and empower” is one of the ten essential services of public

health departments in the U.S. This function has been of paramount importance during the

COVID-19 pandemic, which has been accompanied by a “pandemic of misinformation.”

Competing policy narratives, the undermining of public health leaders by elected officials, and

the dissemination of pseudoscience and conspiracy theories through social media have left

Americans understandably confused and ill-informed” (Basset). Health education competency

was lacking in many communities and led to a greater issue—misinformation; health

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misinformation can be detrimental to many communities, especially when there is already a lack

of healthcare access and resources. According to Claudine Vallecera, “I have observed

inadequacies in health literacy and general knowledge and taking care of oneself after being

confined in the hospital. So when it comes to working with patients, ideally, we provide them

with guides about interventions and safety, discharge plans which include home medication,

future doctor appointments, and health education, before they are discharged.” Health

competencies are definitely lacking in the United States, especially in rural communities, where

there is a lack of healthcare access and education. In aiming to alleviate the growing prominence

of health misinformation, health education inadequacies, and professional shortages, medical

facilities have prioritized public health education and professional training. It is evident that

many healthcare systems have struggled due to scarce resources, burnout healthcare workers, and

administrative incompetencies, which is why it is imperative to implore newer generations to

pursue careers in healthcare: “According to the Council for Public Health Education, to meet this

increasing demand, there is a need for specialized training as part of professional development to

ensure readiness for future similar challenges” (Bashier). Lack of proper health education is one

of the factors that led to the COVID-19 virus to spread like a forest fire; working to promote and

improve the healthcare system with establishing more younger people in the health profession

would help solve some of the prominent issues that arose during the pandemic such as healthcare

inaccessibility and health misinformation. The pandemic revealed the inadequacies in public

health attributed to weak health education and lacking resources.

The pandemic has contributed to many different changes, especially in healthcare,

research, and innovation. If there is one important lesson the pandemic has shown the world, it

would be the importance of prioritizing pandemic preparedness and the urgency of establishing

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more efficient public health authority. To mitigate future pandemics, biomedical preparedness

research, public health measures, and nonpharmaceutical interventions are established strategies

to prepare for possible outbreaks (Whitacre). It is undeniable that it is not the last time that a

novel pathogen such as COVID-19 will spread and cause public health emergencies. In the

United States, there was definitely a delayed response to COVID-19 in many states, so it is

important to take the necessary measures to prepare for such events. Apart from research, there

has been an improvement in technology and innovation to prepare for public health crises and

adjust to the changes in healthcare: “As these and related efforts grow, practitioners will need to

ensure that existing disparities are not magnified. Care is needed to ensure that those with the

highest health needs can access services” (Briss). The pandemic has affected how healthcare is

conveyed or provided. There are so many modes of communication through technology, routine

doctor visits are one of the next definite adjustments. The adoption of telehealth during the

pandemic has expanded the mobility of healthcare in health emergencies and crises; however,

there are still limitations, especially addressing certain health issues that cannot be examined

virtually. Still, many doctor visits that are now conducted online out of safety and even

convenience have changed healthcare delivery. Although, the emergence of technology in

healthcare delivery has been more challenging to integrate into rural communities: “Furthermore,

the cost of telemedicine for rural health clinics is an issue, because many rural patients receive

either Medicare or Medicaid, and reimbursements from these government healthcare programs,

as well as from private insurance companies, do not fully cover the costs of virtual medicine”

(Burse). Implementing virtual systems is not only a financial issue, but also a technological

accessibility issue. Many rural communities have limited or unreliable remote access to

technology, broadband internet service, and cellular telephone reception; rural communities have

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greater limitations in accessing healthcare despite growing advances in healthcare accessibility.

There have been definite improvements in public health, which are attributed to increasing

vaccination rates ever since the COVID-19 vaccines have been introduced. However, there are

still differences in public opinion on vaccinations. In states like Indiana, Missouri, and Texas,

bills have been introduced to limit health department authority in deciding vaccination

requirements in school attendance (Pierce). Innovations, research, and technological advances

have been so important in changing public health and disease awareness, especially in preventing

worsening health conditions in rural communities. The pandemic has transformed many things

for healthcare, but innovation is one of the definite changes in the past few years.

The COVID-19 pandemic streamlined medical innovations, research, and technology,

which have changed public health and disease awareness, to alleviate the failures and

shortcomings in the healthcare system. Underserved communities such as the elderly,

immunocompromised, and impoverished, have gained better access to healthcare through

telehealth, small clinics, and more accessible health education. Socioeconomically disadvantaged

communities and people of color will continue to experience healthcare differently, and it is

important to adjust to their needs to effectively work as healthcare providers. As an aspiring

healthcare worker with current frontline family members, these improvements will not only

fundamentally improve patients’ healthcare experiences, but also improve the quality of care and

the scope of patient care provided by healthcare workers. Although COVID-19 transmission

rates have declined, effects and consequences of COVID-19 are still felt in communities. It is

imperative to know how future pandemics can be prevented and to support the efforts of public

health organizations because the pandemic has shown that viruses can instantaneously cause the

collapse of economies, healthcare and educational systems, and lives.

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Works Cited

Bashier, Haitham et al. “The Anticipated Future of Public Health Services Post COVID-19:

Viewpoint.” JMIR public health and surveillance vol. 7,6 e26267. 18 Jun. 2021,

doi:10.2196/26267. Accessed 26 Jan. 2023.

Basset, Mary et al., “Public Health COVID-19 Impact Assessment: Lessons Learned and

Compelling Needs,” National Academy of Medicine.

https://nam.edu/public-health-covid-19-impact-assessment-lessons-learnedand-compelling

-needs/. Accessed 28 Jan. 2023.

Briss, Peter et. al., “COVID-19 and Chronic Disease: The Impact Now and in the Future,” Center

for Disease Control and Prevention. https://www.cdc.gov/pcd/issues/2021/21_0086.htm.

Accessed 31 Jan. 2023.

Buhat, Gretchen. Personal Interview. 11 March 2023.

Burse, Nakeitra et. al,, “The Role of Public Health in COVID-19 Emergency Response Efforts

From a Rural Health Perspective,” Center for Disease Control and Prevention.

https://www.cdc.gov/pcd/issues/2020/20_0256.htm. Accessed 29 Jan. 2023.

“Introduction to Public Health|Public Health 101 Series|CDC.” Centers for Disease Control and

Prevention, 22 Jan. 2021, www.cdc.gov/training/publichealth101/public-health.html.

Graham, Garth, “Addressing the Disproportionate Impact of COVID-19 on Communities of

Color,” National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC79

78471 Accessed 01 Feb. 2023.

Pierce, Matt. “The Future of Public Health Three Things to Watch for in 2023.” Www.rwjf.org, 3

Feb. 2023, www.rwjf.org/en/insights/blog/2023/02/the-future-of-public-health-three-thin

gs-to-watch-for-in-2023.html.

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“Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19:

Information for Healthcare Professionals.” Centers for Disease Control and Prevention,

Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/

hcp/clinical-care/underlyingconditions.html.

Vallecera, Claudine. Personal Interview. 4 March 2023.

Whitacre, Paula, “Learning from Rapid Response, Innovation, and Adaptation to the COVID-19

Crisis,” Washington, D.C., National Academies of Sciences, Engineering, and Medicine,

2021.

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